#842: The Story Behind EpiPen, The Rise of Food Allergies, and What Doctors Got Wrong

Overview

This episode explores the history, science, and economics behind the EpiPen and the rise of food allergies. It delves into how medical recommendations, unintended consequences, and corporate strategies shaped the current landscape of food allergies and their treatment. The episode also highlights groundbreaking research that challenged long-standing medical advice and offers hope for better allergy prevention and management.

Notable Quotes

- Your fear of your baby developing the disease leads to avoiding the food, leads to causing the baby to have the disease. - Dr. Gideon Lack, on the paradox of food allergy prevention.

- Exposing babies early, as early as four months, was clearly and profoundly beneficial. This prevented food allergies. - Thomas Getz, summarizing the LEAP study findings.

- Do you think you were charging too much at $600? If you thought it was fair, leave it where it’s at. - Congressman, questioning Mylan CEO Heather Bresch on EpiPen price hikes.

🧬 The Rise of Food Allergies

- Food allergies have increased dramatically in recent decades, with 6-10% of children and 10% of adults in the U.S. now affected.

- Historical observations of food allergies date back to ancient Greece, but they were rare until the late 20th century.

- The hygiene hypothesis suggests that modern cleanliness and reduced exposure to microbes may have weakened immune systems, making them more prone to allergies.

- The American Academy of Pediatrics’ 2000 1-2-3 rule advised delaying exposure to common allergens like peanuts, eggs, and dairy. This precautionary principle, though well-intentioned, inadvertently contributed to the rise in food allergies.

💉 The EpiPen: A Life-Saving Device with a Controversial History

- The EpiPen, a device delivering epinephrine to treat anaphylaxis, was first patented in 1977 and FDA-approved in 1987.

- Initially underutilized, the EpiPen gained prominence as food allergies became more common. By 2016, it was a billion-dollar product.

- Mylan Pharmaceuticals acquired the EpiPen in 2007 and raised its price from $109 to over $600 per two-pack by 2016, sparking public outrage and congressional hearings.

- Mylan’s strategies included lobbying, school training programs, and exclusive contracts, creating a lock-in effect that limited competition.

🧪 The LEAP Study and a Paradigm Shift

- Dr. Gideon Lack’s 2008 study found that Israeli children, who were exposed to peanuts early via a snack called Bamba, had significantly lower rates of peanut allergies compared to UK children.

- The LEAP (Learning Early About Peanut Allergy) study, published in 2015, confirmed that early exposure to peanuts reduced allergy rates by 86%.

- This groundbreaking research led to a reversal of medical guidelines in 2017, recommending early and frequent exposure to allergens for infants.

💰 The Economics of Drug Pricing

- Despite public backlash, EpiPen prices have continued to rise, now costing about $700 per two-pack in 2023.

- Mylan’s pricing strategies highlight systemic issues in U.S. drug pricing, where manufacturers have significant leeway to set prices.

- Generic alternatives, like AdrenoClick, exist but face barriers due to lack of training and awareness.

🌱 Hope for the Future: Allergy Prevention and Treatment

- Allergen immunotherapy, or exposure therapy, is being explored as a treatment for existing allergies, involving supervised, gradual exposure to allergens.

- In 2020, the FDA approved Palforzia, a treatment for peanut allergies that reduces the risk of severe reactions.

- Products like Mission Mighty Me, co-founded by Dr. Gideon Lack, aim to help parents introduce allergens early to prevent allergies in future generations.